Stent treatment for cerebral aneurysms has emerged as a novel and effective approach. It enables the gradual occlusion of the aneurysm by placing a stent within the parent artery, thereby reducing the risk of rupture. Recent flow‑diverting stents show promise for complex aneurysm anatomies. Technologies such as Pipeline Embolization Device, Surpass, Silk, Derivo, and FRED stents demonstrate long‑term success and low complication rates. Antithrombotic medications are also critical during treatment to manage potential clotting risks.
| Medical Name | Cerebral Aneurysm Stent Treatment (Endovascular Stent Placement) |
| Affected Areas | Cerebral vessels (most commonly in the Circle of Willis) |
| Etiology | Vessel wall weakness (genetic predisposition, hypertension, atherosclerosis, smoking) |
| Symptoms | Unruptured aneurysms are usually asymptomatic; ruptured aneurysms cause severe headache, nausea, vomiting, loss of consciousness, neurological deficits |
| Diagnostic Methods | Cerebral angiography, magnetic resonance angiography (MRA), computed tomography angiography (CTA) |
| Treatment Methods | Endovascular flow‑diverting stent placement, stent‑assisted coiling (Y‑stent, X‑stent, etc.), open surgery (clip application) |
| Possible Complications | Bleeding, stroke, thrombosis, vessel occlusion, aneurysm regrowth (very rare) |
| Prevention | Blood pressure control, smoking cessation, cholesterol management, regular neuroimaging in high‑risk patients |
| Recovery Time | Several weeks after endovascular stent treatment; full recovery depends on patient condition and aneurysm size |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Stent‑Assisted Coiling?
Stent‑assisted coiling offers a critical approach for treating cerebral aneurysms, especially those with wide necks that are challenging to isolate by traditional methods. A stent is deployed in the parent vessel to prevent coil prolapse and provide scaffolding for secure aneurysm filling.
- After stent deployment, coils are delivered via a microcatheter through the stent.
- High packing density within the aneurysm sac is achieved.
- Hemodynamic changes promote gradual thrombosis of the aneurysm.
Endothelial growth along the stent then facilitates natural aneurysm occlusion.
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How Do Flow‑Diverting Stents Work?
Flow‑diverting stents represent a revolutionary step in cerebral aneurysm therapy by directly modifying blood flow to accelerate aneurysm healing. These devices are placed across the aneurysm neck and feature a fine mesh design that redirects blood away from the aneurysm sac, reducing wall stress and rupture risk.
- They encourage endothelial cell growth across the aneurysm neck.
- A neointimal layer forms over time, sealing the aneurysm naturally.
Flow‑diverters are particularly effective for large, complex, wide‑necked, and fusiform aneurysms without requiring additional coiling.
- They offer lower recurrence rates for large or giant aneurysms.
- No supplemental coils are needed compared to traditional stents.
How Effective Is Stent Treatment for Cerebral Aneurysms?
Stent therapy is among the most effective modern solutions for cerebral aneurysms. Stent‑assisted coiling (SAC) and flow diversion significantly reduce rupture risk while promoting aneurysm occlusion. Devices such as Pipeline, Surpass, Silk, Derivo, and FRED deliver excellent outcomes in large aneurysms.
What Are the Risks and Complications of Stent Placement?
Stent treatment for cerebral aneurysms carries several potential risks and complications that must be managed carefully.
Thromboembolic Events:
- Thrombus formation within or around the stent can occur.
- This may lead to ischemic stroke.
- The first 40 days post‑procedure are the highest risk period.
Hemorrhagic Complications:
- Dual antiplatelet therapy increases bleeding risk.
- Clopidogrel sensitivity can exacerbate hemorrhagic events.
- Subcutaneous and epistaxis bleeding are common minor issues.
Incomplete Stent Apposition:
Poor wall contact, especially in tortuous vessels, may promote thrombosis.
Antiplatelet Management:
Balancing dual antiplatelet therapy duration is critical to minimize both bleeding and thrombotic risks. Some studies suggest switching to single‑agent therapy after one month may reduce bleeding without significantly raising thrombosis risk.
Candidate selection depends on aneurysm anatomy and patient health. Wide‑necked or complex bifurcation aneurysms benefit most. Key factors include:
- Aneurysm size
- Aneurysm shape
- Aneurysm location
Detailed imaging guides stent type selection. Patients with high bleeding risk or recent rupture may be excluded.
Flow diversion involves percutaneous femoral or radial artery access under imaging guidance. A microcatheter navigates to the aneurysm site, and the stent is deployed across the neck. Once expanded, the stent alters flow dynamics instantly. Patients typically stay briefly in hospital and resume normal activities within a week. Antiplatelet therapy is mandatory post‑procedure, and regular follow‑up imaging monitors stent and aneurysm status.
Adherence to antiplatelet medication is essential to prevent thrombosis. Keep the access site clean and dry, monitor for infection, and avoid strenuous activity until cleared. Report severe headache, vision changes, or neurological symptoms immediately. Lifestyle modifications—smoking cessation and blood pressure control—help reduce complications.
Long‑term outcomes vary by device and aneurysm characteristics. For example, LEO Plus stent studies show 73.1% complete occlusion at 5 years, with 14.1% neck remnants and 12.8% persistent aneurysms. WEB plus stent combinations achieve 92.9% occlusion at 12 months with a 5.9% retreatment rate. Neuroform Atlas in posterior circulation yields 76.7% occlusion at 12 months and 4.3% ipsilateral stroke.
Overall complication risk is about 9.4% with stent treatment versus 5.6% without stents. Ischemic events occur in 7.0% of stent cases versus 3.5% without. Hemorrhagic events are 2.3% with stents and 1.9% without. Procedure‑related mortality is 2.7% with stents versus 1.1% without. However, stenting reduces aneurysm recurrence to 15.5% compared to 35.5% without stents. Y‑stenting yields 91% occlusion with 4% permanent morbidity and 2% mortality. Ruptured aneurysm stenting carries an 11% permanent complication rate, 11% early rebleed, and 80% mortality in rebleeds.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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